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The best feature of our biennial Advocacy Retreat, always scheduled just a month before the new Texas Legislature convenes, is the opportunity for TMA and nearly two dozen state specialty societies to stand in front of their peers and explain their key issues for the coming session. We spent several hours in a conversation about how to address priorities, recognizing some of the unique patient care needs of our specialty societies. “The one thing we definitely need is not to have splintering in the house of medicine,” said TMA Council on Legislation Chair Ray Callas, MD. “Let’s work together as a team.”

Led by Dr. Callas and TMA Vice President for Advocacy Darren Whitehurst, our lobby team laid out the top legislative issues TMA has been working on for months. They include the state budget, insurance reform, scope of practice, telemedicine, the Texas Medical Board, and public health priorities.

The most-frequently mentioned priorities for the 23 specialty societies that participated were:

Scope of practice, an especially dicey issue this session because all of the health professionals’ licensing agencies are up for sunset review;

Telemedicine;

Opioid addiction and the prescription drug monitoring database;

Maintaining the momentum we’ve built for expanding graduate medical education; and

Medicaid funding and administrative hassles.

Physician-Lawmakers See Opportunities

The 85th Texas Legislature will gavel in on Jan. 6, with three physicians serving in the Texas Senate and four in the House. All seven are TMA members, and five of them addressed the Advocacy Retreat. While each of them brings different perspectives and priorities to the legislature, a common theme they expressed was the opportunity the election results offer to reshape Texas Medicaid and health care for low-income Texans. They pointed out that President-Elect Donald Trump and U.S. House Speaker Paul Ryan (R-Wis.) both support giving the states more flexibility in designing Medicaid benefits and delivery models. “The stars are lining up” for Medicaid reform, said Rep. John Zerwas, MD (R-Richmond), an anesthesiologist and the senior member of the group. “Texas will drive the national model as to what the solutions should look like.” Senate Health and Human Services Chair Charles Schwertner, MD (R-Georgetown), an orthopedic surgeon, and Sen.-Elect Dawn Buckingham, MD (R-Lakeway), an ophthalmologist, both stressed the opportunity to design a Texas-specific health care program for low-income Texans and the need for more personal responsibility among recipients of those services. The other physician-legislators who shared their wisdom were Rep. J.T. Sheffield, DO (R-Gatesville), a family physician, and Rep.-Elect Tom Oliverson (R-Houston), an anesthesiologist.

Physician to Lead Federal Health Agency

We were very pleased with President-Elect Trump’s announcement that he will nominate U.S. Rep. Tom Price, MD (R-Georgia), an orthopedic surgeon, to be his secretary of health and human services. TMA leaders have an excellent relationship with Dr. Price through his long service in the American Medical Association House of Delegates. “For years, he has targeted government programs like the Physician Quality Reporting System and the misnamed meaningful use program,” TMA President Don Read, MD, said in a statement to the news media. “These and many other federal regulations are no more than paper-pushing exercises that do nothing to improve quality of care.”

TMA Leaders Take MACRA Improvement Ideas to Washington

While most of us were gathered in Austin for the Advocacy Retreat, three TMA leaders joined engaged physicians from around the country in Baltimore to push the Centers for Medicare & Medicaid Services (CMS) for more big changes to the Medicare Access and CHIP Reauthorization Act (MACRA) rules. Organized by U.S. Rep. Pete Sessions (R-Dallas), the gathering included TMA Trustee Rick Snyder, MD, and Drs. Asa Lockhart of Tyler and John Gill of Dallas, both members of the Texas Delegation to the AMA. Here’s our top-six list to fix MACRA:

Keep and/or raise the low-volume threshold to exempt physicians from the Merit-Based Incentive Payment System (MIPS).

Keep the MIPS performance threshold as low as possible for as long as possible.

No quality or cost measure should be used unless it can be attributed properly and risk adjusted, and all measures must be developed and/or vetted in collaboration with the medical profession and relevant stakeholders, not just CMS.

Remove the requirement for all-payer data.

Design a system that provides real-time feedback and meaningful data to physicians.